Agitated delirium associated with therapeutic doses of sustained-release bupropion

Case description We report a case of a patient initiated on therapeutic doses of sustained-release bupropion for the management of major depressive disorder who subsequently developed acute agitated delirium that required ICU level care. This patient’s history was significant for alcohol and cannabi...

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Bibliographic Details
Published in:International journal of clinical pharmacy 2012-02, Vol.34 (1), p.9-12
Main Authors: Mack, Diana R., Barbarello-Andrews, Liza, Liu, Mei T.
Format: Article
Language:English
Subjects:
Adult
Antidepressive Agents, Second-Generation - administration & dosage
Antidepressive Agents, Second-Generation - adverse effects
Antidepressive Agents, Second-Generation - therapeutic use
Bupropion - administration & dosage
Bupropion - adverse effects
Bupropion - therapeutic use
Case Report
Critical Care
Delayed-Action Preparations
Delirium - chemically induced
Depressive Disorder, Major - drug therapy
Dopamine
Dopamine Uptake Inhibitors - administration & dosage
Dopamine Uptake Inhibitors - adverse effects
Dopamine Uptake Inhibitors - therapeutic use
Humans
Internal Medicine
Male
Medicine
Medicine & Public Health
Mental depression
Pharmacology
Pharmacy
Psychomotor Agitation
Psychotropic drugs
Risk Factors
Side effects
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Summary:Case description We report a case of a patient initiated on therapeutic doses of sustained-release bupropion for the management of major depressive disorder who subsequently developed acute agitated delirium that required ICU level care. This patient’s history was significant for alcohol and cannabis abuse but he was currently detoxified and beyond the withdrawal period. Throughout the course of treatment, all maintenance medications, including bupropion, were discontinued and the patient required escalating doses of benzodiazepines and typical antipsychotics to resolve symptoms. The patient’s delirium subsided after approximately 5 days. Conclusion Dopamine is thought to play a role in the pathophysiology of delirium and given the mechanism of action of this drug and the presence of delirium risk factors in our patient, we are faced with a likely causative factor of this acute delirious episode.
ISSN:2210-7703
2210-7711
DOI:10.1007/s11096-011-9587-x